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Renal Exam 2 > Lect 6 > Flashcards

Lect 6 Flashcards

1
Q

hemodialysis

A

blood is removed from the body, filtered, then put back into the body

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2
Q

peritoneal dialysis

A

Used peritoneal layer/ membrane act as a membrane inside the body then empty out peritoneal cavity and replace more fluid

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3
Q

KDOQI recommendation for planning dialysis

A

Stage 4 CKD or CrCl less than 30 mL/min

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4
Q

when is dialysis access created?

A

GFR less than 25 mL/min
SCr >4
1 year prior to anticipated need for dialysis

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5
Q

when does KDOQI recommend evaluating for dialysis?

A

GFR or CrCl less than 15 mL/min/1.73 m2

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6
Q

when is dialysis access created?

A

GFR 4

1 year prior to anticipated need for dialysis

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7
Q

when does KDOQI recommend evaluating for dialysis?

A

GFR or CrCl

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8
Q

indications for dialysis

A

LOOK AT SLIDE

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9
Q

how do you evaluate uremia?

A

BUN

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10
Q

what are the basic principles of diffusion in hemodialysis?

A

molecular weight, conc gradient, memb resistance, blood and dialysate flow rates

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11
Q

what are the basic principles of ultrafiltration in hemodialysis?

A

transmembrane pressure (TMP), ultrafiltration coefficient (Kuf)

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12
Q

conventional or standard dialyzers

A

small pores limit clearance to small molecules (urea and creatinine)
low blood flow rates

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13
Q

high efficiency dialyzers

A

large surface area (so increase capacity to remove water, urea, small molecules)
high blood flow rates

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14
Q

high flux dialyzers

A

large pores increase removal of high mol-weight substances

high blood flow rates

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15
Q

high flux dialyzers

A

large pores increase removal of high mol-weight substances

high blood flow rates

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16
Q

what is the dialysate solution composed of?

A

purified water and electrolytes (glucose, Na, K, Ca) –> actual quantities specified by physician
similar to body fluids but lacking waste products

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17
Q

dialysis solution bases

A

added to neutralize acid (since normal metabolism prod acids that ESRD pts are unable to clear)

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18
Q

examples of dialysis solution bases

A
  1. acetate= converted by liver to bicarb; has more adverse effects
  2. bicarbonate= $$$, drug of choice in liver impairment and severe acidosis
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19
Q

what is the major challenge for success and long-term feasibility of HD?

A

vascular access

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20
Q

AV fistula

A

anastomosis of a vein and artery

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21
Q

advantages of AV fistula

A

longest survival, lowest complications, increased survival and decreased hospitalizations, most cost-effective

22
Q

disadvantages of AV fistula

A

takes 1-2 months to mature, diff to create in elderly or PVD pts

23
Q

AV synthetic graft

A

graft connects the artery and vein

24
Q

advantages of AV synthetic draft

A

easily implanted

longer survival than catheters

25
disadvantages of AV synthetic graft
shorter survival than fistula higher rates of complications than fistulas 2-3 weeks to endothelialize prior to use
26
disadvantages of AV synthetic graft
shorter survival than fistula higher rates of complications than fistulas 2-3 weeks to endothelialize prior to use
27
venous catheters
femoral, subclavian, or internal jugular vein | least desirable access
28
advantages of venous catheters
immediate use | easy to place and remove
29
disadvantages of venous catheters
short survival higher risk of infection may not provide adequate blood flow
30
urea reduction ratio
% of blood being cleared of urea | (predialysis BUN- postdialysis BUN) / predialysis BUN x 100
31
what is an adequate urea reduction ratio?
>60%
32
Kt/V
unitless parameter | fraction of total body water cleared of urea
33
what is an adequate urea reduction ratio?
>60% | measure monthly and adjust dialysis
34
Kt/V
unitless parameter fraction of total body water cleared of urea K= dialyzer clearance of urea t= time V= total volume of water in body (0.6 x weight in kg)
35
how do you interpret Kt/V?
mortality increases as Kt/V decreases | Kt/V of 1.2 is approx = URR of 63%
36
intermittent hemodialysis
PRN basis | most commonly: 3 sessions/week with 3-5 hours/session
37
continuous hemodialysis
based on access
38
hemodialysis pros and cons
LOOK AT SLIDE
39
basic principles of diffusion in peritoneal dialysis
molecular weight conc gradient memb resistance
40
basic principles of ultrafiltration in peritoneal dialysis
osmotic force (dextrose and icodextrin)
41
what can you alter in peritoneal dialysis?
NOT BLOOD FLOW OR PERMEABILITY dialysate volume dwell time exchanges per day
42
what can you alter in peritoneal dialysis?
NOT BLOOD FLOW OR PERMEABILITY dialysate volume dwell time exchanges per day
43
continuous ambulatory peritoneal dialysis (CAPD)
manual dialysate exchanges adv= independence disadv= infection risk
44
automated peritoneal dialysis (APD)
automatic cycler performs exchanges (throughout the night) adv= fewer exchanges in daytime, sterility, convenience disadv= machine in bedroom
45
types of APD
1. ) continuous cycling peritoneal dialysis (CCPD) 2. ) tidal peritoneal dialysis 3. ) nightly intermittent peritoneal dialysis
46
continuous cycling peritoneal dialysis (CCPD)
APD with "wet" day (long daytime dwell)
47
tidal peritoneal dialysis
initial partial fill, then drain, then replace | creates tidal flow
48
nightly intermittent peritoneal dialysis
APD with "dry" day (no daytime dwell)
49
intermittent peritoneal dialysis
normally reserved for acute pts machine operator high cost, high risk of infection
50
PD pros and cons
LOOK AT SLIDE

Renal Exam 2 (10 decks)

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